Download - HEART-LUNG TRANSPLANTATION Overall ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
HEART-LUNG TRANSPLANTATION
Overall
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
0
50
100
150
200
250
300
Nu
mb
er
of
Tra
ns
pla
nts
ISHLT 2012
NOTE: This figure includes only the heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of heart-lung transplants worldwide has declined in recent years.J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 2000 - June 30, 2011
1/year 2/year 3/year 4-9/year0
5
10
15
20
25
30
35
40
45
50
55
60
0
5
10
15
20
25
30
35
40
45
50
55
60
55
41
4 7
Number of centers Percentage of transplants
Average number of heart-lung transplants per year
Nu
mb
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of
Ce
nte
rs
% o
f H
ea
rt-L
un
g T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME
Heart-Lung Transplants: January 1, 2000 - June 30, 2011
1-4 5-9 10-19 20-29 30-39 40-49 50+0
5
10
15
20
25
30
35
40
Average number of lung transplants per year
% o
f H
ea
rt-L
un
g T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for All Ages(Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 230
20
40
60
80
100
Years
Su
rviv
al (
%)
N = 4,225
Half-life = 3.2 yearsConditional Half-life = 9.7 years f
N at risk at 23 years = 22
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
HEART-LUNG TRANSPLANTATION
Adult Recipients
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2011)
Acquired heart disease
5%
Congenital heart disease36%
COPD/Alpha-16%
CF14%
IPF4%
IPAH28%
Re-transplant2%
Sarcoidosis2%
Other4%
ISHLT 2012
“Other” includes cancer, LAM, OB, bronchiectasis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2011)
ISHLT 2012
Diagnosis N (%)
Congenital Heart Disease 1,134 (35.7%)
Idiopathic Pulmonary Arterial Hypertension 877 (27.6%)
Cystic Fibrosis 448 (14.1%)
Acquired Heart Disease 160 (5.0%)
COPD/Emphysema 133 (4.2%)
Idiopathic Pulmonary Fibrosis 115 (3.6%)
Alpha-1 61 (1.9%)
Sarcoidosis 52 (1.6%)
Re-Transplant: Not Obliterative Bronchiolitis 36 (1.1%)
Re-Transplant: Obliterative Bronchiolitis 22 (0.7%)
Bronchiectasis 30 (0.9%)
Obliterative Bronchiolitis (not Re-Transplant) 24 (0.8%)
Other 88 (2.8%)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA (Transplants: January 1982 - June 2011)
ISHLT 2012
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1982-1991 (N=959)
1992-2001 (N=1,453)
2002-6/2011 (N=768)
Other
Sarcoidosis
Re-TX
IPF
COPD/Alpha-1
Acquired Heart Disease
CF
IPAH
Congenital Heart Disease
% o
f T
ran
sp
lan
ts
“Other” includes OB (non-ReTX) and Bronchiectasis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANTSMajor Indications By Year (%)
ISHLT 2012
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
10
20
30
40
50
60
70
80
90
100
Congenital Heart Disease IPAH Cystic Fibrosis
COPD/Alpha-1 Retransplant Acquired Heart Disease
Transplant Year
% o
f T
ran
sp
lan
ts
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANTSMajor Indications By Year (Number)
ISHLT 2012
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
20
40
60
80
100
120
140
160
180
Congenital Heart Disease IPAH Cystic Fibrosis
COPD/Alpha-1 Retransplant Acquired Heart Disease
Transplant Year
Nu
mb
er
of
Tra
ns
pla
nts
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANTSAge Distribution By Location
(Transplants: January 2000 - June 2011)
ISHLT 2012
Europe North America Other0%
20%
40%
60%
80%
100%
18 - 34 years 35 - 49 years 50 - 59 years 60+ years
% o
f T
ran
sp
lan
ts
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANTSDiagnosis Distribution By Location(Transplants: January 2000 - June 2011)
ISHLT 2012
Europe North America Other0%
20%
40%
60%
80%
100%
Congenital heart disease IPAH Cystic Fibrosis Acquired heart disease IPF Other
% o
f T
ran
sp
lan
ts
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANTS Donor Age Distribution By Location
(Transplants: January 2000 - June 2011)
ISHLT 2012
Europe North America Other0%
20%
40%
60%
80%
100%
6-11 12-17 18-34 35-49 50-59 60+
% o
f D
on
ors
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANTS Kaplan-Meier Survival
(Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 220
25
50
75
100
Years
Su
rviv
al (
%)
N = 3,544
Half-life = 3.3 yearsConditional Half-life = 10.0 years f
N at risk at 23 years = 18
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANTS Kaplan-Meier Survival by Era
(Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 100
25
50
75
100
1982-1991 (N=1,210)1992-2001 (N=1,588)
Years
Su
rviv
al (
%)
p-value comparing all < 0.0001
Half-life (Years): 1982-1991 = 1.9; 1992-2001 = 3.7; 2002-6/2010 = 6.1 Conditional Half-life (Years): 1982-1991 = 8.9; 1992-2001 = 10.0; 2002-6/2010 = NA
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANTSKaplan-Meier Survival By Diagnosis
(Transplants: January 1990 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
25
50
75
100
Other Congenital (N = 319)
Eisenmenger's Syndrome (N = 621)
IPAH (N = 638)
Years
Su
rviv
al (
%)
Congenital vs. Eisenmenger's: p = 0.0248Congenital vs. IPAH: p = 0.0788Eisenmenger's vs. IPAH: p = 0.4168
HALF-LIFE Congenital: 2.8 Years; Eisenmenger's: 5.5 Years; IPAH: 4.5 Years
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANTSKaplan-Meier Survival By Diagnosis Conditional on Survival
to 1 Year (Transplants: January 1990 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
25
50
75
100Other Congenital (N = 178)
Eisenmenger's Syndrome (N = 413)
IPAH (N = 431)
Years
Su
rviv
al (
%)
Congenital vs. Eisenmenger's: p = 0.6985Congenital vs. IPAH: p = 0.4258Eisenmenger's vs. IPAH: p = 0.1062
HALF-LIFE Congenital: 13.6 Years; Eisenmenger's: 11.1 Years; IPAH: 10.1 Years
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG RECIPIENTS Cross-Sectional Analysis
Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2011)
ISHLT 2012
1 Year (N = 264) 3 Years (N = 213) 5 Years (N = 181)0%
20%
40%
60%
80%
100%
No Activity Limitations Performs with Some AssistanceRequires Total Assistance
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients
US Recipients Only(Follow-ups: March 2005 – June 2011)
ISHLT 2012
0%
20%
40%
60%
80%
100%
1 Year (N = 145) 2 Years (N = 107)
3 Years (N = 94)
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG RECIPIENTS Employment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2011)
ISHLT 2012
0%
20%
40%
60%
80%
100%
1 Year (N = 348)3 Years (N =
246)5 Years (N =
220)
Working (FT/PT sta-tus unknown)
Retired
Not Working
Working Part Time
Working Full Time
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 – June 2011)
ISHLT 2012
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 441)
Between 2 and 3 Years (N = 314)
Between 4 and 5 Years (N = 258)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Only Hospitalized, Infection Only
Hospitalized, Rejection and Infection
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression
(Transplants: January 2001 – June 2011)
ISHLT 2012
Any Induction (N=174)
Polyclonal ALG/ATG
(N=66)
OKT3 (N=5) IL-2R Antagonist (N=87)
0
10
20
30
40
50
60
70
% o
f P
ati
en
ts
Analysis is limited to patients who were alive at the time of the discharge
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression
(Transplants: January 2000 – December 2010)
ISHLT 2012
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100
Any Induction Polyclonal ALG/ATG
OKT3 IL-2R Antagonist
% o
f P
ati
en
ts
Analysis is limited to patients who were alive at the time of the discharge
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression
(Transplants: January 2000 – December 2010)
ISHLT 2012
2000
2002
2004
2006
2008
2010
2000
2002
2004
2006
2008
2010
2000
2002
2004
2006
2008
2010
2000
2002
2004
2006
2008
2010
0
10
20
30
40
50
60
70
80
90
% o
f P
ati
en
ts
Any Induction Polyclonal ALG/ATG
OKT3 IL-2R Antagonist
Analysis is limited to patients who were alive at the time of the discharge
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 – June 2011)
ISHLT 2012
Cyclosporine Tacrolimus Sirolimus/Everolimus
MMF/MPA Azathioprine Prednisone0
10
20
30
40
50
60
70
80
90
100
Year 1 (N = 206) Year 5 (N = 130)
% o
f P
ati
en
ts
Analysis is limited to patients who were alive at the time of the follow-up
NOTE: Different patients are analyzed in Year 1 and Year 5
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at
Time of Follow-up (Follow-ups: January 2001 – June 2011)
ISHLT 2012
0%
20%
40%
60%
80%
100%
Year 1 (N = 206)
Year 5 (N = 130)
Other
None
Sirolimus/Everolimus + Calcineurin + Cellcycle
Sirolimus/Everolimus + Calcineurin
Tacrolimus
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine + MMF/MPA
Cyclosporine + AZA
Analysis is limited to patients who were alive at the time of the follow-up
NOTE: Different patients are analyzed in Year 1 and Year 5
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2011)
ISHLT 2012
Outcome Within 1 Year
Total number with known response
Hypertension 59.0% (N = 405)
Renal Dysfunction 18.7% (N = 439)
Abnormal Creatinine < 2.5 mg/dl 11.8%
Creatinine > 2.5 mg/dl 3.0%
Chronic Dialysis 3.6%
Renal Transplant 0.2%
Hyperlipidemia 26.7% (N = 427)
Diabetes 19.0% (N = 441)
Coronary Artery Vasculopathy 3.2% (N = 348)
Bronchiolitis Obliterans Syndrome 8.4% (N = 415)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2011)
ISHLT 2012
Outcome Within 5 Years
Total number with known response
Hypertension 88.1% (N = 143)
Renal Dysfunction 46.2% (N = 169)
Abnormal Creatinine < 2.5 mg/dl 32.5%
Creatinine > 2.5 mg/dl 10.1%
Chronic Dialysis 2.4%
Renal Transplant 1.2%
Hyperlipidemia 69.3% (N = 150)
Diabetes 28.1% (N = 167)
Coronary Artery Vasculopathy 8.0% (N = 87)
Bronchiolitis Obliterans Syndrome 26.4% (N = 140)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Coronary Artery Vasculopathy and Bronchiolitis Obliterans Syndrome
For Adult Heart-Lung Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 840
50
60
70
80
90
100
Freedom from Coronary Artery Vasculopathy
Freedom from Bronchiolitis Obliterans Syndrome
Years
% F
ree
fro
m C
AV
an
d B
ron
ch
iolit
is
Ob
lite
ran
s S
yn
dro
me
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients By Diagnosis Type
(Follow-ups: April 1994 – June 2011)
0 1 2 3 450
60
70
80
90
100
Heart (N=195)
Lung (N=56)
Heart/Lung (N=89)
Years
% F
ree
fro
m C
AV
p-value comparing all = 0.5290
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Bronchiolitis Obliterans SyndromeFor Adult Heart-Lung Recipients By Diagnosis Type
(Follow-ups: April 1994 – June 2011)
0 1 2 3 450
60
70
80
90
100
Heart (N=226)
Lung (N=69)
Heart/Lung (N=111)
Years
% F
ree
fro
m B
ron
ch
iolit
is O
blit
-e
ran
s S
yn
dro
me
p-value comparing all = 0.8796
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 950
60
70
80
90
100
Years
% F
ree
from
Sev
ere
Ren
al D
ysfu
nct
ion
*Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Morbidity Rates in Survivors
(Follow-ups: April 1994 – June 2011)
ISHLT 2012
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 421 (94.2%) 155 (88.6%) 50 (83.3%)
Malignancy (all types combined) 26 (5.8%) 20 (11.4%) 10 (16.7%)
Malignancy Type*
Skin 2 7 9
Lymphoma 18 6 0
Other 4 5 2
Type Not Reported 2 2 0
* Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from MalignancyFor Adult Heart-Lung Recipients
(Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
All malignancy
Lymphoma
Skin
Other
Years
% F
ree
fro
m M
alig
na
nc
y
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANT RECIPIENTSCause of Death (Deaths: January 1992 – June 2011)
ISHLT 2012
CAUSE OF DEATH 0-30 Days (N = 385)
31 Days - 1 Year (N = 311)
>1 Year - 3 Years (N = 250)
>3 Years - 5 Years (N = 160)
>5 Years (N = 393)
BRONCHIOLITIS 0 11 (3.5%) 62 (24.8%) 36 (22.5%) 80 (20.4%)
ACUTE REJECTION 7 (1.8%) 9 (2.9%) 5 (2.0%) 2 (1.3%) 3 (0.8%)
LYMPHOMA 0 11 (3.5%) 15 (6.0%) 8 (5.0%) 11 (2.8%)
MALIGNANCY, OTHER 1 (0.3%) 4 (1.3%) 10 (4.0%) 5 (3.1%) 23 (5.9%)
CMV 0 2 (0.6%) 0 1 (0.6%) 1 (0.3%)
INFECTION, NON-CMV 68 (17.7%) 109 (35.0%) 74 (29.6%) 44 (27.5%) 97 (24.7%)
GRAFT FAILURE 109 (28.3%) 67 (21.5%) 34 (13.6%) 26 (16.3%) 54 (13.7%)
CARDIOVASCULAR 28 (7.3%) 12 (3.9%) 19 (7.6%) 14 (8.8%) 34 (8.7%)
TECHNICAL 86 (22.3%) 10 (3.2%) 3 (1.2%) 3 (1.9%) 3 (0.8%)
OTHER 86 (22.3%) 76 (24.4%) 28 (11.2%) 21 (13.1%) 87 (22.1%)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART-LUNG TRANSPLANT RECIPIENTS Relative Incidence of Leading Causes of Death
(Deaths: January 1992 – June 2011)
0-30 Days (N = 385)
31 Days – 1 Year (N = 311)
>1 Year – 3 Years (N = 250)
>3 Years – 5 Years (N = 160)
>5 Years (N = 393)
0
10
20
30
40
50 Bronchiolitis Infection (non-CMV) Graft Failure Cardiovascular
Technical
% o
f D
ea
ths
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
HEART-LUNG TRANSPLANTATION
Pediatric Recipients
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2011)
<1 1-5 6-11 12-170
50
100
150
200
250
300
350
400
21
105
381
165
Recipient Age (Years)
Nu
mb
er
of
Tra
ns
pla
nts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTSTransplants: January 1982 - June 2011
0-11 12-17 18-34 35-49 50-590
50
100
150
200
250
300
350
400376
109
56 39
6
Donor Age (Years)
Nu
mb
er
of
Tra
ns
pla
nts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS BY YEAR
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
0
5
10
15
20
25
30
35
40
45
50
55
60
65
12-17 Years
1-11 Years
<1 Year
Nu
mb
er
of
Tra
ns
pla
nts
ISHLT 2012
NOTE: This figure includes only the heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of pediatric heart-lung transplants worldwide has declined in recent years.J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS BY ERA OF TRANSPLANT
ISHLT 2012
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1982-1996 1997-6/2011
12-17 Years
1-11 Years
<1 Year
% o
f T
ran
sp
lan
ts
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
0
5
10
15
20
25
30
Transplant Year
N o
f P
ed
iatr
ic T
ran
sp
lan
t C
en
ters
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
Stratified by center volume
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
0
5
10
15
20
25
30
1-4/yr 5-9/yr
10-19/yr 20-29/yr
Transplant Year
N o
f P
ed
iatr
ic T
ran
sp
lan
t C
en
ters
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DIAGNOSIS IN PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS (Transplants: 1986-2010)
ISHLT 2012
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
25
50
75
100Cystic Fibrosis Congenital IPAH
% o
f C
as
es
NOTE: Unknown diagnoses were excluded from this tabulation.
4%
28%22%
12%
2%24%
2% 2%4%
Acquired Heart DiseaseCFCongenital (other)Eisenmenger's SyndromeIPFIPAHRetx: Non-OBRetx: OBOther
“Other” includes Bronchiectasis, Alpha-1, and OB (non-ReTX)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART-LUNG TRANSPLANTSAge Distribution By Location
(Transplants: January 2000 – June 2011)
ISHLT 2012
Europe North America Other0%
20%
40%
60%
80%
100%
0-5 years 6-11 years 12-17 years
% o
f T
ran
sp
lan
ts
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART-LUNG TRANSPLANTSDiagnosis Distribution By Location(Transplants: January 2000 – June 2011)
ISHLT 2012
Europe North America Other0%
20%
40%
60%
80%
100%
Congenital heart disease Cystic Fibrosis IPAH Other
% o
f T
ran
sp
lan
ts
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART-LUNG TRANSPLANTS Donor Age Distribution By Location
(Transplants: January 2000 – June 2011)
ISHLT 2012
Europe North America Other0%
20%
40%
60%
80%
100%
0-5 6-11 12-17 18-34 35-49
% o
f D
on
ors
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART-LUNG TRANSPLANTSKaplan-Meier Survival By Diagnosis
(Transplants: January 1990 - June 2010)
0 1 2 3 4 5 6 7 80
25
50
75
100Congenital (N = 97)
Eisenmenger's Syndrome (N = 51)
IPAH (N = 107)
Years
Su
rviv
al (
%)
Congenital vs. Eisenmenger's: p = 0.2274Congenital vs. IPAH: p = 0.0220Eisenmenger's vs. IPAH: p = 0.4776
HALF-LIFE Congenital: 1.9 Years; Eisenmenger's: 2.6 Years; IPAH: 4.7 Years
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART-LUNG TRANSPLANTSKaplan-Meier Survival (Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170
25
50
75
100< 1 (N = 21)
1-11 (N = 264)
12-17 (N = 375)
Overall (N = 660)
Years
Su
rviv
al (
%)
0-<1 vs. 1-11: p = 0.0004 0-<1 vs. 12-17: p = 0.0001 1-11 vs. 12-17: p = 0.1218
Half-life <1: 0.2 Years;1-11: 3.0 Years; 12-17: 3.5 Years
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART-LUNG TRANSPLANTSKaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
25
50
75
1001982-1989 (N = 182)
1990-1996 (N = 267)
1997-2003 (N = 135)
2004-6/2010 (N = 76)
Years
Su
rviv
al (
%)
No pair-wise comparisons are significant at <0.05 except 1982-1989 vs. 2004-6/2010 (p = 0.0212)
Half-life 1982-1989: 1.9; 1990-1996: 3.3; 1997-2003: 3.0; 2004-6/2010: NA
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART-LUNG TRANSPLANTSKaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Conditional on Survival to 1 Year
0 1 2 3 4 5 6 7 8 9 10 11 12 130
25
50
75
1001982-1989 (N = 100) 1990-1996 (N = 178)
1997-2003 (N = 82) 2004-6/2010 (N = 58)
Years
Su
rviv
al (
%)
No pair-wise comparisons are significant at <0.05 except 1990-1996 vs. 1997-2003 (p = 0.0131)
Conditional HALF-LIFE 1982-1989: 9.6; 1990-1996: 6.4; 1997-2003: 13.8; 2004-6/2010: NA
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTSCause of Death (Deaths: January 1992 – June 2011)
ISHLT 2012
CAUSE OF DEATH 0-30 Days (N = 48)
31 Days - 1 Year (N = 59)
>1 Year - 3 Years(N = 55)
>3 Years - 5 Years (N = 39)
>5 Years(N = 62)
BRONCHIOLITIS 0 3 (5.1%) 27 (49.1%) 16 (41.0%) 18 (29.0%)
ACUTE REJECTION 0 2 (3.4%) 1 (1.8%) 2 (5.1%) 1 (1.6%)
LYMPHOMA 0 3 (5.1%) 2 (3.6%) 1 (2.6%) 2 (3.2%)
MALIGNANCY, OTHER 0 1 (1.7%) 0 1 (2.6%) 0
CMV 0 2 (3.4%) 0 0 0
INFECTION, NON-CMV 8 (16.7%) 18 (30.5%) 4 (7.3%) 1 (2.6%) 16 (25.8%)
GRAFT FAILURE 18 (37.5%) 12 (20.3%) 13 (23.6%) 12 (30.8%) 12 (19.4%)
CARDIOVASCULAR 3 (6.3%) 3 (5.1%) 2 (3.6%) 2 (5.1%) 3 (4.8%)
TECHNICAL 11 (22.9%) 0 3 (5.5%) 2 (5.1%) 0
OTHER 8 (16.7%) 15 (25.4%) 3 (5.5%) 2 (5.1%) 10 (16.1%)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTSCause of Death (Deaths: April 1994 – June 2011)
ISHLT 2012
CAUSE OF DEATH0-30 Days(N = 39)
31 Days - 1 Year (N = 44)
>1 Year - 3 Years (N = 44)
>3 Years - 5 Years (N = 34)
>5 Years (N = 62)
BRONCHIOLITIS 0 1 (2.3%) 21 (47.7%) 14 (41.2%) 18 (29.0%)
ACUTE REJECTION 0 1 (2.3%) 1 (2.3%) 2 (5.9%) 1 (1.6%)
LYMPHOMA 0 3 (6.8%) 2 (4.5%) 1 (2.9%) 2 (3.2%)
MALIGNANCY, OTHER 0 1 (2.3%) 0 1 (2.9%) 0
CMV 0 1 (2.3%) 0 0 0
INFECTION, NON-CMV 4 (10.3%) 15 (34.1%) 4 (9.1%) 1 (2.9%) 16 (25.8%)
GRAFT FAILURE 15 (38.5%) 9 (20.5%) 10 (22.7%) 11 (32.4%) 12 (19.4%)
CARDIOVASCULAR 3 (7.7%) 2 (4.5%) 2 (4.5%) 1 (2.9%) 3 (4.8%)
TECHNICAL 9 (23.1%) 0 1 (2.3%) 1 (2.9%) 0
OTHER 8 (20.5%) 11 (25.0%) 3 (6.8%) 2 (5.9%) 10 (16.1%)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS Relative Incidence of Leading Causes of Death
(Deaths: April 1994 – June 2011)
0-30 Days(N = 39)
31 Days - 1 Year (N =44)
>1 Year - 3 Years (N = 44)
>3 Years - 5 Years (N = 34)
>5 Years(N = 62)
0
10
20
30
40
50
60 Bronchiolitis Infection (Non-CMV) Graft Failure Cardiovascular
% o
f D
ea
ths
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095